Provider Demographics
NPI:1336544683
Name:JOBE, SUSAN LEANNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEANNE
Last Name:JOBE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DELUXE CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3030
Mailing Address - Country:US
Mailing Address - Phone:706-647-7509
Mailing Address - Fax:706-647-6624
Practice Address - Street 1:101 DELUXE CIR
Practice Address - Street 2:SUITE B
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3030
Practice Address - Country:US
Practice Address - Phone:706-647-7509
Practice Address - Fax:706-647-6624
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN204511363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily